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Evaluation of Operatively Managed Adhesive Small Bowel Obstruction: Does Waiting Affect Outcomes?
John Afthinos*, Karen E. Gibbs
Staten Island University Hospital, Bayside, NY
Introduction: Adhesive small bowel obstruction (SBO) is a common surgical problem. We sought to evaluate different timeframes for non-operative management prior to operative intervention, and whether the timing of surgical intervention affects ultimate outcome.
Methods: The Nationwide Inpatient Sample Database (NIS) was queried from 2005 to 2010 for admissions for adhesive SBO. There were 4 operative groups: laparoscopic lysis of adhesions (LLOA), open lysis of adhesions (LOA), laparoscopic converted to open lysis of adhesions (Converted) and open lysis of adhesions and small bowel resection (SBR). Each group was subdivided based on the number of days before operation: 0 - 1, 2 -5, and >5 days. Multivariate logistic regression was performed to identify risk factors leading to post-operative morbidity and mortality.
Results: A total of 227,819 patients were identified. 30,054 (13%) underwent LLOA, 128,035 (56%) underwent LOA, 57,544 (25%) underwent SBR and 12186 (5%) were Converted. The LOA group demonstrated increasing risk for mortality at the 2-5 day and >5 day interval (OR 1.3, p-value 0.001 and OR 1.8, p-value <0.001 respectively). The LLOA group had an increased risk for post-operative morbidity in the 2-5 day subgroup (OR 2.4, p-value 0.03). The SBR group had increased mortality at 2-5 days (OR 2.3 p-value 0.02) and >5 days (OR 3.3, p-value 0.01). The converted group undergoing operation >5 days after admission had an increased risk of mortality (OR 2.7, p-value <0.0001).
Conclusions: Overall, earlier intervention reduces the risk of post-operative morbidity and mortality in adhesive SBO. A SBR significantly increases morbidity and mortality. A high index of suspicion and earlier intervention may help mitigate this issue.
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